Eleven-year trends in socioeconomic inequalities in the prevalence and incidence of pharmacologically treated type 2 diabetes in France, 2010-2020.

AIM: This study aimed to describe the association between socioeconomic inequalities and the prevalence and incidence of pharmacologically-treated type 2 diabetes in European France over the 2010-2020 period. METHODS: Diabetes cases were identified using a validated algorithm from the French National Health Data System. Analysis was restricted to adults aged 45 years and older to focus on type 2 diabetes. Socioeconomic inequalities were measured for all years in European France using the French deprivation index (FDep, 2015 version), which is an area-based deprivation indicator using population-weighted quintiles (Q1 corresponds to the least deprived municipalities). The relative risks of diabetes prevalence and incidence associated with FDep quintiles (Q1 as the reference) were estimated by sex using a log-linear Poisson model adjusted for year, age and French department. The study population was the French health consumers aged 45 years and over (from 24,228,526 in 2010 to 29,772,928 in 2020). RESULTS: A positive gradient was observed in the relative risks of type 2 diabetes prevalence and incidence by FDep quintiles over the study period. The strength of the estimated associations increased over the last decade for prevalence among men and women and for incidence among men in the two most deprived quintiles. CONCLUSION: Thus, type 2 diabetes prevention should include a proportionate universalism approach, proposing actions of greater intensity in the most deprived areas.

Prevalence, demographic and spatial distribution of treated epilepsy in France in 2020: a study based on the French national health data system.

BACKGROUND: Although still incomplete, the epidemiology of epilepsy shows substantial variations in the burden of the condition according to demographic, social and territorial characteristics. This study aimed to estimate the prevalence of treated epilepsy and to investigate its demographic and spatial distribution in 2020 in France, a country where the nationwide epidemiological situation of the condition remains largely unknown. METHODS: We used the French national health data system, which covers nearly the entire population residing in France (over 67 million of inhabitants in metropolitan and overseas departments). Prevalent cases were identified using long-term disease status, hospitalisation for epilepsy (ICD-10 codes G40 or G41), and reimbursements for antiseizure medications and electroencephalograms. RESULTS: In 2020, we identified 685,122 epilepsy cases, corresponding to an overall prevalence of 10.2 per 1000 inhabitants [95% confidence interval 10.1-10.2], with similar rates in men and women. Estimates were found to increase with age, with an accelerated rise in the second half of the life, which occurred earlier in men than in women. We observed a monotonic gradient of variation with socio-economic deprivation (in non-military metropolitan subjects aged 18-54 years) as well as territorial heterogeneity, with the mountainous centre of France as well as some French overseas departments having the highest prevalence. CONCLUSIONS: Our results revise upwards the estimation of epilepsy prevalence in France, showing that it now ranks among the highest in developed countries. Our study also confirms the important socio-territorial heterogeneity of the condition that reflects health inequalities in this country.

Prevalence and Determinants of Transient Congenital Hypothyroidism in Children With Eutopic Gland in France: A Retrospective Cohort Study.

CONTEXT: The increase in the incidence of congenital hypothyroidism (CH) reported worldwide may partly be explained by an increase in the transient form of CH. OBJECTIVE: We aimed to estimate the proportion of transient CH (TCH) in France, and to identify associated neonatal and young child characteristics. METHODS: We used probabilistic record linkage to link children with eutopic gland born between 2006 and 2012 recorded in the national French CH registry and the French national health data system (SNDS). Of the 703 children recorded, 484 (68.8%) were linked. We retrospectively examined reimbursement for oral levothyroxine (LT4) between January 1, 2006, and December 31, 2017. Children who had discontinued treatment for 6 months or more before December 31, 2017, were classified as having TCH. We used a Cox model to examine the factors associated with TCH. RESULTS: Among the main study sample (n = 471), 53.5% were female, 14.2% were preterm, and 13.8% had low birth weight. One-quarter (n = 111, 24.3%) had mild CH (thyroid-stimulating hormone [TSH] < 50 mU/L, serum) at diagnosis and a median LT4 dose at treatment initiation of 30 µg/day. One-third (n = 155, 32.9%) had TCH. Premature birth (adjusted hazard ratio = 2.1 [1.0-4.2]), a TSH < 50 mU/L at CH screening (7.4 [3.2-17.1]), LT4 dose received at 12 months of age (0.98 [0.97-0.99, P = 0.003]), congenital cardiac malformations (6.6 [1.5-29.0]), and year of birth (1.2 [1.1-1.4]) were all associated with TCH. CONCLUSION: One-third of the children had TCH, and it was associated with several characteristics at birth and postpartum. These data are useful for CH medical management and epidemiological surveillance.

Obstructive sleep apnea: A sharp increase in the prevalence of patients treated with nasal CPAP over the last decade in France.

INTRODUCTION: Obstructive sleep apnea (OSA) is a frequent condition. In the absence of treatment, OSA is associated with a higher risk of traffic accidents and a large variety of diseases. The objectives of this study were to describe the characteristics of patients treated for OSA in France and assess the time trends in treatment. METHODS: The French National Health Data System is an individual database with data on all healthcare reimbursements for the entire French population. Based on this database, we included all patients aged 20 years or over who were treated with continuous positive airway pressure (CPAP) or mandibular advancement splint (MAS) between 2009 and 2018. Negative binomial models, adjusted for age, were used to assess time trends in treatment prevalence and incidence rates. RESULTS: In 2017, 2.3% of French adults aged ≥20 years were treated with CPAP (men: 3.3%; women: 1.3%). The highest prevalence was observed in people aged 70-74 years (5.0%). From 2009 to 2018, the annual prevalence of CPAP increased 3-fold and the annual incidence 1.9-fold. During the same period, the rate of patients reimbursed for MAS (first prescription or renewal) was multiplied by 7.6. The proportion of patients treated with CPAP in 2017 who were no longer treated in the subsequent year was 6.9%. DISCUSSION: The sharp increase in the incidence of OSA treatment probably reflects a better recognition of the disease in France. However, the prevalence of OSA treatment remains lower than expected based on the international literature. Further studies are needed to identify the obstacles to an optimal management of individuals with OSA in France.

Trends in childhood type 1 diabetes incidence in France, 2010-2015.

AIMS: To estimate type 1 diabetes incidence in children in France and its evolution between 2010 and 2015, based on comprehensive medico-administrative databases. METHODS: The algorithm built to identify new cases of type 1 diabetes selected children aged between 6 months and 14 years who had at least one hospital stay for diabetes, followed by their first insulin treatment, excluding children suffering from another form of diabetes. Age and sex specific annual incidence rates were estimated and time trend was analyzed using Poisson regression. RESULTS: A total of 12 067 children were identified as newly diagnosed with type 1 diabetes and the annual incidence rates increased between 2010 and 2015 (from 15.4 [95% Confidence Interval: 14.7; 16.1] to 19.1 [18.3; 19.9] per 100 000 person-years), among boys and girls, and in each age group (4 and under, 5-9, 10-14 year olds). The annual rate of increase was 4.0% [3.4; 4.6]. This trend was not significantly different between each gender, and each age group. CONCLUSIONS: Valid database information on disease incidence is essential for healthcare planning and provides a valuable resource for health research. An increase of the incidence rate of type 1 diabetes in children was highlighted in both sexes and in all age groups.

Identifying diabetes cases in health administrative databases: a validation study based on a large French cohort.

OBJECTIVES: In the French national health insurance information system (SNDS) three diabetes case definition algorithms are applied to identify diabetic patients. The objective of this study was to validate those using data from a large cohort. METHODS: The CONSTANCES cohort (Cohorte des consultants des Centres d'examens de santé) comprises a randomly selected sample of adults living in France. Between 2012 and 2014, data from 45,739 participants recorded in a self-administrated questionnaire and in a medical examination were linked to the SNDS. Two gold standards were defined: known diabetes and pharmacologically treated diabetes. Sensitivity, specificity, positive and negative predictive values (PPV, NPV) and kappa coefficients (k) were estimated. RESULTS: All three algorithms had specificities and NPV over 99%. Their sensitivities ranged from 73 to 77% in algorithm A, to 86 and 97% in algorithm B and to 93 and 99% in algorithm C, when identifying known and pharmacologically treated diabetes, respectively. Algorithm C had the highest k when using known diabetes as the gold standard (0.95). Algorithm B had the highest k (0.98) when testing for pharmacologically treated diabetes. CONCLUSIONS: The SNDS is an excellent source for diabetes surveillance and studies on diabetes since the case definition algorithms applied have very good test performances.